Healthcare Provider Details

I. General information

NPI: 1659288637
Provider Name (Legal Business Name): CHEYENNE RYAN BURROWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 NE GLISAN ST
PORTLAND OR
97213-2933
US

IV. Provider business mailing address

1626 NW 38TH AVE
CAMAS WA
98607-8519
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-1111
  • Fax:
Mailing address:
  • Phone: 360-558-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: